HB2049

SECTION 1. The legislature finds that the public welfare would be best served by requiring the insurance commissioner to regulate dental insurance rates to ensure that they are not excessive, inadequate, or unfairly discriminatory.

The purpose of this Act is to expand the insurance commissioner's powers to regulate health insurance rates to include dental insurance rates.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by amending the title of article 14G, to read as follows:

"[[]ARTICLE 14G[]]

HEALTH AND DENTAL INSURANCE RATE REGULATION"

SECTION 3. Section 431:14G-101, Hawaii Revised Statutes, is amended to read as follows:

"[[]§431:14G-101[]] Scope and purpose. (a) This article shall apply to all types of health insurance offered by managed care plans[.] and dental insurance offered by a dental insurance provider.

(b) The purpose of this article is to promote the public welfare by regulating health insurance and dental insurance rates to the end that they shall not be excessive, inadequate, or unfairly discriminatory. Nothing in this article is intended to:

(1) Prohibit or discourage reasonable competition; or

(2) Prohibit or encourage, except to the extent necessary to accomplish the aforementioned purposes, uniformity in insurance rates, rating systems, rating plans, or practices.

This article shall be liberally interpreted to carry into effect this section."

SECTION 4. Section 431:14G-102, Hawaii Revised Statutes, is amended as follows:

1. By adding a new definition to be appropriately inserted and to read:

""Dental insurance provider" means any person who undertakes to provide or to arrange for or administer one or more dental insurance plans."

2. By amending the definition of "enrollee" to read:

""Enrollee" means a person who enters into a contractual relationship or who is provided with health care services or benefits through a managed care plan[.] or dental care services or benefits by a dental insurance provider."

SECTION 5. Section 431:14G-104, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Except as otherwise provided by law, the commissioner may mandate filings for health and dental insurance under section 431:14G-105 when the commissioner has actuarially sound information that current rates may be excessive, inadequate, or unfairly discriminatory."

SECTION 6. Section 431:14G-105, Hawaii Revised Statutes, is amended by amending subsection (i) to read as follows:

"(i) The commissioner, by written order, may suspend or modify the requirement of filing as to any class of health or dental insurance, subdivision, or combination thereof, or as to classes of risks, the rates which cannot practicably be filed before they are used. The order shall be made known to the affected managed care plan[.] or dental insurance provider. The commissioner may make examinations that the commissioner deems advisable to ascertain whether any rates affected by the order meet the standards set forth in section 431:14G-103."

SECTION 7. Section 431:14G-105, Hawaii Revised Statutes, is amended by amending subsection (k) to read as follows:

"(k) The commissioner may make the following rate effective when filed: any special filing with respect to any class of health or dental insurance, subdivision, or combination thereof that is subject to individual risk premium modification and has been agreed to under a formal or informal bid process."

SECTION 8. Section 431:14G-107, Hawaii Revised Statutes, is amended by amending subsection (d) to read as follows:

"(d)(1) Any enrollee of a managed care plan, dental insurance provider, or organization that purchases health insurance from a managed care plan or dental insurance from a dental insurance provider aggrieved with respect to any filing that is in effect may make a written demand to the commissioner for a hearing thereon; provided that the managed care plan or dental insurance provider that made the filing shall not be authorized to proceed under this subsection;

(2) The demand shall specify the grounds to be relied upon by the aggrieved enrollee or organization and the demand shall show that the enrollee or organization has a specific economic interest affected by the filing;

(3) If the commissioner finds that:

(A) The demand is made in good faith;

(B) The applicant would be so aggrieved if the enrollee's or organization's grounds are established; and

the commissioner, within thirty days after receipt of the demand, shall hold a hearing. The hearing shall be held upon not less than ten days' written notice to the aggrieved party and to every managed care plan that made the filing. The aggrieved party shall bear the burden of proving that the filing fails to meet the standards set forth in section 431:14G-103; and

(4) If, after the hearing, the commissioner finds that the filing does not meet the requirements of this article, the commissioner shall issue an order specifying in what respects the filing fails to meet the requirements of this article, and stating when, within a reasonable period, the filing shall be deemed no longer effective. Copies of the order shall be sent to the applicant and to every affected managed care plan. The order shall not affect any contract or policy made or issued prior to the expiration of the period set forth in the order."

SECTION 9. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 10. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

HOUSE OF REPRESENTATIVES	H.B. NO.	2049
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII